by Simon Sullivan BHSc MOstMed
Back pain is the most common reason that people visit an Osteopath, it is so ubiquitous that 80% of us will experience back pain sometime in our lives.
So it makes sense that we should get all the information we can about our backs so we can make the best possible treatment choices and what better way than the magic of Magnetic Resonance Imaging that allows us to see inside us with unprecedented detail, the same can be said for CT scans and X-rays as well.
Well this is wrong for all but a few cases -
Australian (and American and everywhere else) guidelines clearly state that unless there is serious neurological impairment or signs of underlying pathology imaging is not needed. Worse, a large study in the US has shown that that getting a MRI early on in acute episodes of low back pain, even cases with nerve compression pain such as sciatica and controlling for severity and age led to significantly worse outcomes, such as $13,000 more in medical costs and more time off work - All by getting a better look at their spine.
So why does this happen?
Well there a couple of really important reasons...
Firstly, MRI’s are really sensitive, they can pick up many different changes and abnormalities in your spine and the soft tissues around it. Words like degeneration, loss of disc height, annular tears, disc bulges, disc herniation, osteophytes, calcification, and stenosis might be used. Problem is that these things probably have very little to do with why you are in pain. MRI anyone’s back over a certain age and you are likely to find some or all of these “findings” whether they are in pain or not.
The correlation between MRI findings and back pain is almost so poor it is non-existent. They are regularly false alarms.
The cause of back pain is often due to functional problems relating to muscle imbalances, joint movement and lifestyle choices that will never show up on a MRI but are what Osteopaths look for and treat every day.
Now go back and re read that list of MRI findings… If they showed up on a scan of your back how would you feel?
Concerned, fearful, despondent? Some common things I hear are…. “I have the back of an 80 year old”… “My back is stuffed” … “My disc is bulged/slipped/popped/blown/gone” … “My back will never be good”. - Unfortunately this type of thinking is a powerful driver of pain and it is heavily reinforced by often unrelated MRI findings.
Pain is more than the nerve impulses being sent to the brain from an area in trouble, it involves our thoughts, emotions, environment and the map we have of our body in our brain and if all this is telling us our back is broken and can’t be fixed than the chances of that pain becoming chronic is much more likely.
So what should we do about this?
Well the good news is that for large majority of people pain levels tend to reduce substantially over the first 4-6 weeks of an episode even if you do nothing. But this often leaves people with a low level annoying pain that can hang around many months.
As an Osteopath my approach would be to get in early if possible and treat the myofascial and joint dysfunctions that may exist to restore as much function and movement as possible. At the same time working to identify as many of the underlying factors that may have predisposed and maintained these dysfunctions as possible to create lasting change.
Just before we finish I would just like to put in one caveat. Remember I said that an MRI and most imaging is unnecessary in all but a few cases? Well in these cases it’s vital and includes conditions like cancer, fractures and underlying inflammatory and autoimmune conditions. Thankfully these are rare and tell-tale symptoms should be picked up on examination by your health professional.
So next time you have an experience of back pain just remember that you are more than your MRI findings and get the help you need to live without pain.
Some light reading…
Iatrogenic Consequences of Early Magnetic Resonance Imaging in Acute, Work-Related, Disabling Low Back Pain
Barbara S. Webster, BSPT, PA-C,* Ann Z. Bauer, MPH,† YoonSun Choi, MA,* Manuel Cifuentes, MD, MPH, ScD,*†and Glenn S. Pransky, MD, MOccH*
Evidence-Based Management of Acute Musculoskeletal Pain
Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations.
Brinjikji W, Luetmer PH, Comstock B, et al.
AJNR Am J Neuroradiol. 2015 Apr;36(4):811–6. PubMed #25430861. PainSci #53872.
The prognosis of acute and persistent low-back pain: a meta-analysis
Luciola da C. Menezes Costa, Christopher G. Maher, Mark J. Hancock, James H. McAuley, Robert D. Herbert, Leonardo O.P. Costa
Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis
Helge Franke, Jan-David Franke and Gary FryerEmail author
BMC Musculoskeletal Disorders201415:286